Provider Demographics
NPI:1649356882
Name:METOXEN, KRISTIN LAUREL (LPC)
Entity type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:LAUREL
Last Name:METOXEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8215 GREENWAY BLVD STE 160
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-3689
Mailing Address - Country:US
Mailing Address - Phone:920-366-3227
Mailing Address - Fax:
Practice Address - Street 1:8215 GREENWAY BLVD STE 160
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-3689
Practice Address - Country:US
Practice Address - Phone:262-999-3495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3848-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional